Ch-19 Alteration in Hormonal Regulation Flashcards
What are the two diseases of posterior pituitary?
SIADH & Diabetes insipidus
What is another name for ADH?
vasopressin
If there is no ADH, the collecting duct is ____ permeable to water and large volume of urine is produced.
NOT
If there is an excess secretion of ADH from PP = water ____(1) & ___-osmolarity (2)
If there is a reduced secretion of ADH from PP = water _____(3) and ECF _____osmolarity (4)
reabsorption (1); hypo (2); absorption (3); hyper (4)
Which disease of PP occurs when there is a presence of high ADH levels?
SIADH
What are the common causes of SIADH? (3 pts)
(1) ectopic secretion of ADH by tumours
(2) surgery
(3) meds
What type of meds are associated with SIADH?
HYPOglycemic meds, opioids, antidepressants, anti-inflammatory
What tumours are associated with SIADH?
Cancers - stomach, duodenum, pancreas
Lymphomas, sarcomas (bone cancers)
CNS disorders - encephalitis and meningitis
How does surgery affect SIADH?
any surgery increased ADH up to 5-7 days
What is the key feature of SIADH?
increased water reabsorption to peritibular capillaries.
For SIADH, if there is increased ADH secretion, there is _____(1) water channel proteins.
increased
SIADH: If there is an increased water reabsorption in ECF = ___-____ in ECF
hypo-osmolarity.
What is the difference between normal osmolarity/ hyperosmolarity/ hypo-osmolarity?
Normal: match between Na and H2O
HYPER: more Na than H2O
HYPO: less Na than H2O
What are some manifestations for SIADH?
HYPOnatremia – low Na in blood
What are the effects of SIADH in our body?
dependent upon severity and rapidity of onset
How much does the serum Na levels decrease if people has SIADH?
Note: It decreases rapidly!
140-130 mmol/L
How much is the serum Na level of a person with SIADH if they are showing symptoms like VOMITING, ABDOMINAL CRAMPS & WEIGHT GAIN?
130-120 mmol/L
How much is the serum Na level of a person with SIADH if they are showing symptoms like CONFUSION, LETHARGY, MUSCLE TWITCHES & CONVULSIONS?
below 130 mmol/L
T or F: Symptoms of SIADH usually resolve with correction of hyponatremia.
TRUE
Which PP disorder is associated with insufficiency of ADH activity leading to polyuria and polydipsia?
diabetes insipidus
What is polyuria and polydipsia?
polyuria – fq. urine
polydipsia – fq. drinking
What are the 2 forms of diabetes insipidus?
Neurogenic (or central) & Nephrogenic
What are the 2 types of Nephrogenic?
acquired and genetic
What is the cause of Neurogenic?
- low ADH from PP
- lesions on hypothalamus
- PP interference with transport/release of ADH
- brain tumours, aneurysm
T or F: Diabetes insipidus is a well-recognized complication of TBI.
TRUE
Acquired or Genetic DI: Related to medication disorders that damage renal tubes.
What are the associated disorders?
ACQUIRED
Polycystic & Pyelonephritis
What is polycystic and pylonephritis?
Polycystic kidney disease – gen. disorder that cause many fluid filled cysts to grow in kidneys
Pylonephritis – urinary tract infection
Acquired or Genetic DI: Mutation of gene coding for aquaporon-2.
Genetic DI
What is the associated mutation for genetic DI?
aquaporon- 2
What is a rare DI?
if its associated with pregnancy.
T or F: DI with pregnancy requires tx.
FALSE; doesnt require tx and is usually mild
DI with pregnancy: Increase in level of vasopressin-degrading enzyme ______
vasopressinase
For DI: Insufficient ADH = large volume of ____ (1) urine = _____ (2) plasma osmolarity
- dilute
- increased
T or F: Serum HYPERnatremia and HYPERosmolarity is associated with DI
TRUE
What are some clinical signs for DI? (3pts)
polyuria
nocturia
polydipsia
What is nocturia?
walking up at night to urinate
What is the normal urinary output? What is pt with DI’s urinary output?
Normal urinary output: 1-2L/day
DI urinary output: 8-12L/day -can be higher than daily fluid intake.
What is the result of longstanding DI?
enlarged bladder capacity & Hydronephrosis.
What is hydronephrosis?
swelling of one or both kidneys
What is the difference in terms of onset between nephrogenic DI and neurogenic DI?
Nephrogenic DI: gradual onset
Neurogenic DI: sudden onset
What are some diagnosis for DI? (4pts)
- dilute urine
- hypernatremia
- hyperosmolarity
- continue diuresis
What are some tx for DI?
-ADH replacement
- oral or IV fluid replacement
- NEW tx: reversing acquaporing-2 dysfunction
- meds like carbamazepine (e.g., Tegretol)
Thyroid function disorder is due to ____ (1) dysfunction of ____ (2) gland.
- primary
- thyroid
Why does secondary dysfunction of thyroid gland occurs?
because of pituitary or hypothalamic alterations.
What is a subclinical thyroid disease?
thyroid disease with NO symptoms but AB lab values.
What is the difference between HYPErthyroidism & Thyrotoxicosis?
Thyrotoxicosis – CONDITION that result in any cause of INCREASED thyroid hormone levels
HYPERthyroidism – EXCESS secretion of thyroid hormone from thyroid gland.
What are disease associated with HYPERthyroidism? (2pts)
- Graves Disease
- Toxic multinodular goiter
What are some features of thyrotoxicosis?
caused by metabolic effects of INCREASED serum thyroid hormones.
For thyrotoxicosis: If there is increased metabolic rate = there is increased _____ _____ (1) tolerance = increase tissue sensitivity to SNS stimulation
heat intolerance
What are some differences between HYPO and HYPER? (5pts each)
HYPOthyroidism
- periorbital edema
- constipation
- edema of extremities
- bradycardia
- smaller thyroid
HYPERthyroidism
- enlarged thyroid
- exopathalmos
- diarrhea
- pretibial edema
- tachycardia
What is the difference between exopathalmos and periorbital edema? Which symptoms is associated with hypo and hyper thyroid?
Exopathalmos – bulging protruding eyeballs; HYPER
Periorbital edema – swelling around eyes – HYPO
What percentage of Graves’ Disease leads to the underlying cause of hyperthyroidism?
80%
T or F: Graves’ disease is more common in women. Also the exact cause is unknown.
TRUE
Graves’ disease is an ______ (1) disease. As a result, ______(2) stimulate receptors on thyroid gland.
autoimmune (1); autoantibodies (2)
What antibodies override normal regulatory mechanisms in Graves’ disease?
thyroid-stimulating immunoglobulins (TSIs)
In Graves’ disease, TSI stimulation = _______ (1) of gland and ______ (2) secretion of TH (esp T_ (3))
- hyperplasia
- increased
- T3
Manifestations of Graves disease due to TSIs? (2pts)
- ab from HYPERACTIVITY of SNS
- Change of orbital contents with ENLARGEMENT of orbital muscles
What are the results of the manifestations of Graves’ disease?
- Exopathalmos, Diplopia, & decreased visual acuity.
- Pretibial myxedema
What is the difference between diplopia and exopathalmos?
diplopia – double vision
exopathalmos – protusion of eyeball
What is pretibial myxedema?
subcutaneous swelling of anterior portion of legs.
What is the cause of the swelling of pretibial edema?
recruited T cells stimulate excessive amounts of hyaluronic acid.
What is hyaluronic acid?
a natural substance found in fluids in eyes and joints
What is toxic multinodular goitre?
several nodules increase in size and increase TH output, thus increases size of thyroid gland.
What are some characteristics of thyrotoxic crisis/
- rare
- dangerous – death can occur within 24 hrs without tx.
- occurs in individuals having Graves’ disease and subjected to infection, pulmonary or cardiovascular disorder.
T or F: Thyrotoxic crisis can occur due to thyroid surgery.
TRUE
What is the difference between primary and central (secondary) hypothyroidism?
Primary – accounts for most cases
Central – related to pituitary, or hypothalamic failure.
What is the common cause of primary hypothyroidism in Canada?
autoimmune thyroiditis (Hashimoto’s disease)
What is the cause of autoimmune thyroiditis?
infiltration of autoreactive T cells, NK cells, and induction of apoptosis
What does autoimmune thyroiditis leads to?
gradual inflammatory destruction of thyroid tissue.
What thyroid disorder occurs in infants when thyroid tissue is absent or with hereditary defects in TH synthesis?
Congenital Hypothyroidism
T or F: TH is essential for embryonic growth particularly brain tissue.
TRUE
Fetus is dependent upon maternal (_____ (1) wha type of TH) for the first ____(2) weeks of gestation. Thus lack can result in ______ (3) defects.
T4 (1); 20 weeks (2); cognitive (3)
What are some symptoms of congenital hypothyroidism? (3 pts)
- high birth weight
- hypothermia
- neonatal jaundice
For congenital hypothyroidism, ______ (1) cord examination can provide T___(2) & ____ (3) levels.
umbilical (1); T4 (2); TSH (3)
What is the tx for congenital hypothyroidism?
levothyroxine BEFORE child is 4 months old
T or F: Without screening, hypothyroidism may be difficult to determine before 4 months
True
What are the symptoms of congenital hypothyroidism? (4 pts)
difficulty eating, horse cry, PROTRUDING CRY, excessive sleeping.
What is the most common pediatric chronic disease? What % of Canadians have this form of diabetes?
Type 1 diabetes mellitus; 10%
T or F: Type 1 Diabetes Mellitus has only association with environmental factors like meds and viruses.
FALSE; HAS BOTH ASSOCIATION WITH GENETIC AND ENVIRONMENTAL FACTORS.
Pathophysio of Type 1 DM: There is a ___ (1) progressing autoimmune __-_____-_____ (2) disease that destroys _____ (3) cells.
In terms of genetic environmental interaction, there is formation of ______ (4) expressed on pancreatic ____ (5) cells. Thus autoantigens detach/circulate in bloodstream and lymphatics. As a result, there is activation of __-____ (6) cells and _____ (7) and production of autoantibodies occurs.
These effects result in pancreas ___ ____ (8) destruction = reduced _____ (9) secretion.
- slow
- T-cell-mediated
- pancreatic
- autoantigens
- beta
- T-cytotoxic
- macrophages
- beta cell
- insulin
Type 1 DM: For insulin secretion to decline enough that ______ (1) develops ____-___% (2) of beta cells must be destroyed.
- hyperglycemia
- 80-90%
Manifestations for Type 1 DM?
- insulin deficiency and hyperglycemia situation
- glucose build up in urine and blood — results in diuresis = dramatic increase in thirst
With type 1 DM, the lack of insulin, ____ (1) and ____ (2) become utilized leading to high levels of circulating KETONES, causing _____ _____ (3)
- fats
- proteins
- Diabetic ketoacidosis
Type 2 DM accounts for ___% of all diabetes in Canada.
90%
What are the risk factors for Type 2 DM? (5 pts)
age, obesity, hypertension, physical activity, family history
The occurrence of type 2 DM linked to more than ___ (1) genes which code for ___ (2) cell mass and functionality.
Resulted 2 mechanisms: _____ ____ (3) & decreased ____ ____ (4) by beta cells
- 60
- beta
- insulin resistance
- insulin secretion
What is metabolic syndrome?
a list of disorders predict a high risk type 2 DM
Type 2 DM Pathophysio:
A ___-___ (1) response of insulin- sensitive tissue (esp, liver, muscle and adipose tissue) = condition of ____ (2) resistance
What are the the mechanisms involved?
- sub-optimal
- insulin
Three mechanisms:
1. Obesity
2. Elevated levels of free fatty acid
3. obesity link to hyperinsulinemia
What is beta-cell exhaustion?
decrease beta-cell mass and dysfunction of normal beta cell function
What syndrome is associated with chronic exposure to excess cortisol?
Cushing’s syndrome
People with cushing’s syndrome have chronic exposure to excess ____
cortisol
Cushing’s disease is the result of excess secretion of ____ (1) by anterior pituitary or an _____-_____ (2) nonpituitary tumour.
- ACTH
- ectopic-secreting
Pathophysio of CD (hypercoticolism):
1. Normal ____ (1) secretion patters of ACTH and corticol are ____ (2).
- There is ____ (3) increased ACTH and cortisol secretion in response to ____ (4)
Result:
Excess ACTH secretion but loss of ____- _____ (5) controls on ACTH secretion.
Symptoms of _____ (6) develop
- diurnal
- lost
- no
- stress
- negative-feedback
- hypercorticolism
What are the manifestations for Cushing’s disease?
- weight gain – face, trunk, buffalo hump
- weakened integumentary tissue = stretched skin
- suppression of immune system
- vertebral compression fractures, kyphosis, and reduced height.
What is kyphosis?
outward curvature of the spine “humpback”
